Your perineum

Your perineum may be tucked well out of sight down there but it has a vital part to play in the birth of your baby because it’s the area that stretches to allow your baby to exit your body. It’s likely that the mere thought of just how much it needs to stretch might have you wondering if a cesarean might be a better option but this isn’t the case. Your perineum is designed to accommodate your baby’s head – and there’s a lot you can do to ensure that it does so without complications.

How does the birth affect your perineum?

Despite its ability to stretch, your perineum (which is the area of skin and muscle that separates your vagina and anus) is at risk of tearing during childbirth if it doesn’t have time to stretch sufficiently. And if birth complications occur that mean your baby needs to be born straightaway or you need an assisted delivery with forceps or vacuum extraction, you may need to have a surgical cut in your perineum. Called an episiotomy, this enlarges your vaginal opening so your baby can be delivered more easily.

You’re more likely to incur damage to your perineum with your first baby (conversely, perineal damage is less likely with a second or subsequent baby), and it’s also more common if you’re pushing for a particularly short or long period of time or you have a fast birth You’re also at higher risk of damage if your baby’s head is large or he is in an awkward position. This may result in his brow presenting first instead of the top of his head and as his brow is wider your perineum won’t have time to gradually stretch to accommodate the rest of his head, as happens when the top of his head presents. And lying on your back to deliver your baby also makes perineal trauma more likely.

Preparing your perineum for childbirth

Although it isn’t guaranteed to prevent tearing there’s evidence that perineal massage during pregnancy may help protect you as you deliver your baby (it also may reduce the likelihood of needing an episiotomy). Aim to do it twice each day from around week 34 onwards. Thoroughly wash your hands, ensure your fingernails are trimmed short and follow these steps:

While sitting in a comfortable semi-reclined position, rub a lubricant such as KY jelly, olive oil or vitamin E oil on your thumbs and perineum.
Place your thumbs 1 to 1½ inches inside your vagina and press downwards and to the sides until you feel a slight tingling or burning sensation. Hold the pressure until the tingling or burning fades.
Now use your thumbs to massage your vagina, stretching the skin in the same way your baby’s head will, and rubbing in the lubricant.

Protecting your perineum during the birth

Your birth position can influence how much perineal trauma you sustain. Giving birth while lying on your side, kneeling or on all fours means your baby’s head places less stress on your perineum. A slow, controlled delivery also eases pressure on the area, so listen to your OB-GYN or midwife as your baby’s head crowns (emerges from the vagina) – she can guide you in when to push so that the widest part of your baby’s head delivers slowly. She likely will encourage you to pant at this time to slow things down and minimize tearing.

Consider a water birth – warm water may help to soften the perineal tissues, making them more flexible, as well as making you feel more relaxed. If you don’t have access to a birthing pool or don’t wish to have a water birth, warm compresses placed on your perineum during your labor and as your baby’s head crowns may help increase its flexibility (some research also suggests these may help relive pain).

Your perineum after the birth

You’ll feel tender down below after your baby is born and it can take some time for bruising to heal. Starting Kegel exercises immediately after the birth promotes bloodflow to the pelvic area and can help promote healing.

If you tore during the birth it may be left to heal by itself if it is a small tear. Larger tears will need to be stitched. Your OB-GYN or midwife will keep a close eye on the stitches to ensure the area doesn’t become infected and taking care to keep it clean will help prevent this. You may find it stings when you urinate but pouring a cup of tepid water over yourself as you pee can relieve this. After washing, gently pat the area dry as rubbing may irritate the healing tissues and any stitches. If your stitches seem excessively uncomfortable or the area is particularly painful, alert your caregiver.

Many women dread their first bowel movement after the birth, especially if they incurred a tear that needed stitches, or if they had an episiotomy. Make it easier on yourself by including plenty of fiber (fresh fruit and vegetables and whole grains) in your diet to avoid straining on the toilet. It may reassure you to hold a clean sanitary pad against your stitches when you pass a bowel movement.

Sex also can be scary after the birth – if you had stitches you might feel tight down below. It’s best to wait until after your post-birth checkup, which takes place around six weeks after the birth, to resume your sex life. Go easy the first time and use lots of lubricant.

The information in this feature is intended for educational purposes only. If you have any concerns about your health, the health of your child or the health of someone you know, please consult with a doctor or other healthcare professional.

Related Articles

Last Modified: 08/03/2009

Send to a friend

perineal damage perineal trauma perineal tear perineal massage